GuidelinesOther guideline
Hyperemesis Gravidarum
This booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.
This is excessive vomiting in pregnancy. It usually occurs in the first few months, & rarely continues into the second or third trimesters. Though some vomiting does.
Well patients can be managed as outpatients. Unwell, dehydrated patients require admission. Indication for admission is ketonuria.
Diagnosis
- It may be associated with twin pregnancy & hydatidiform mole
- Other causes of vomiting should be excluded
- There are no physical signs except of pregnancy & dehydration
- Differential diagnoses include:
- Pyelonephritis/urinary tract infection
- Gastrointestinal complaint, e.g. gastritis, appendicitis, cholecystitis
- Thyroid disorders
- Medicines & alcohol
Investigations
- Urine dipstick – for ketones, & for evidence of UTI
- U&E – to detect hypokalaemia & dehydration
- Urine for MC&S if there is any suspicion of UTI
- Thyroid function
- Ultrasound to assess pregnancy, & encourage the patient with evidence of viability & to exclude hydatidiform mole
Management
Mild hyperemesis (no ketonuria):
- Admission to hospital is not necessary
- Explain to the patient the condition does not harm the fetus
- Advise that the patient does not need to eat while she is feeling ill, only liquid is essential. Advise small frequent meals
- Advise avoidance of anything that causes nausea, e.g. coffee, tea, toothpaste, fatty foods
- Advise the problem is self-limiting, & rarely goes beyond 16 weeks
- Advise the patient to return if the vomiting worsens
- Prescribe metoclopramide (Maxalon) 10 mg orally three times daily when necessary, or cyclizine (Valoid) 50 mg orally three times daily when necessary
Moderate to severe hyperemesis (ketonuria)
- Admit the patient
- Withhold meals for a day or two if vomiting is severe
- IVI with normal saline or Ringer-Lactate. Avoid glucose-containing solutions. Add potassium 20-40 mmol/L if necessary
- Antiemetics: prochlorperazine (Stemetil) 12.5 mg IM 8 hourly (10mg orally), or Metoclopramide10 mg IM or orally 8 hourly or cyclizine 50 mg IM or orally 8 hourly when necessary
- Be alert for hypotension, dehydration or liver dysfunction